There was a battle last week among those who commented on the survey question about human papillomavirus (HPV) vaccination.

There was a battle last week among those who commented on the survey question about human papillomavirus (HPV) vaccination.

The one-third of respondents who indicated that HPV vaccination should not be encouraged mentioned quite a few problems and asked quite a few questions, including:

Where is the data regarding the vaccine's superiority to pap smear?

What is the long-term toxicity?

What about the debilitating side effects?

Who will pay for a broader educational effort to encourage vaccination?

"Pap smears detect cancer; they do nothing to prevent cancer," countered one of the 57% of voters who favored vaccination along with a broader educational campaign to encourage it.

There were parallels drawn to the autism/vaccine debate, but in this case, "the tables were turned on us and the parents focus on sexual activity not cancer prevention," said a reader.

Some readers responded to comments about the potential for the vaccines to cause harm, by comparing them to "medications as common as Tylenol that can produce in some people a rare deathly liver failure," but this is not a reason to avoid the drug.

Another reader had this response to the naysayers: "Complete 'junk science' and 'fearmongering' regarding 'debilitating side effects' of this vaccine. The benefits far outweigh the risks."

"That old mantra -- that the risk is worth the benefits -- is seriously outdated," said a woman who advised against her grandchildren receiving the vaccine.

What about teaching sexual morality?, a reader suggested. The answer came from another commenter: "Because [sex education is] not a moneymaker for pharmaceutical companies."

Indeed, Big Pharma got slammed by readers as did the government for its close relationship with industry.

One reader shared a story about a physician who attempted to get information from the Department of Health and Human Services (HHS) about its financial arrangements with Merck, the company that makes Gardasil (HPV quadrivalent types 6, 11, 16 and 18).

According to the reader, HHS receives a royalty for every Gardasil vaccine sold. The physician wanted to know the amount of the royalty, the annual license fee, and other related arrangements. The government's response, he said, was that a "special federal law exempts any and all such financial information from discovery by the public through Freedom of Information Act requests."

Another reader noted that the "nature of some of the comments clearly shows how much education is needed."

One reader noted the multiple studies, such as PATRICIA and FUTURE, showing a better than 90% efficacy in preventing neoplasia and carcinoma in vaccinated women without evidence of prior HPV exposure, as well as an efficacy prevent rate of about 50% for women with known HPV infection who were subsequently vaccinated.

She said that Kaiser Permanente is conducting an ongoing investigation of vaccination in males and intermediate results show similar protection against HPV infection as for women.

There were poignant stories about the devastating effects of cancer, in particular, a P16+ throat lesion in one commenter's husband, which "made me promote this vaccine to all who will listen."

And a comment about the distress of working in clinics that treat sexually transmitted diseases and seeing "many young patients crying, thinking their lives are over."

But there were equally poignant stories about harm from the vaccinations.

One reader, a hospice nurse, lambasted her physician who continually claimed her daughter's hives were not caused by the vaccine (after each of three shots). The daughter has had hives everyday for a year. "I wanted to protect my child against cervical cancer and instead gave her an autoimmune disease," she said.

And the story of another family that "believed in the system" but has "learned a hard lesson." Their daughter has had a constant headache for almost 3 years, after two vaccine shots. She had to give up school and extracurricular activities. She has chest, muscle, and joint pain. Fatigue keeps her in bed for months.

"How can people justify this and say that stories like this are fearmongering? Until you have experienced this with your child, you have no right to judge," she said.

Another reader commented on the above examples of harm, saying, "Both of these cases are very sad illnesses, but to lay claim to [an HPV vaccine] may well be overreaching."

But even doctors writing in the New England Journal of Medicine have advised that caution may be warranted "in light of important unanswered questions about overall vaccine effectiveness, duration of protection, and adverse effects that may emerge over time," pointed out a reader.

The final word comes from a physician who challenged his colleagues with the following:

"We are losing the trust of our patients. We do not need 100% immunization rates. Originally, we were taught that 60% was enough. Are we hurting some children? Can we win back trust by being cautious and careful?

"We know how overuse of antibiotics has led to dangerous levels of resistance," he pointed out. "Who prompted us to overuse them? Did we do good by listening to them? While dealing with infants and children, abundant caution should be the rule."

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